Get Mgcrb Group Application For 2016 Pdf, 143kb - Cms

This guide provides step-by-step instructions for completing the MGCRB Group Application for 2016. Designed to assist users at all levels of expertise, it covers each section and field of the form, ensuring that you can navigate the application process with confidence.

Follow the steps to successfully complete your application.

1. Use the ‘Get Form’ button to access the MGCRB Group Application for 2016 PDF. This will open the form for you to begin filling it out.
2. Begin by entering your group information in Section I. Specify the county where the hospitals are located and provide the identification code for that area.
3. In the next field, list the contact information for all communications regarding this application, including the name, organization, address, email address, and telephone number.
4. For Item 4, use the prescribed format to list all IPPS hospitals in the county. Include details such as hospital name, address, Medicare provider number, and indicate if they are filing an individual application.
5. In Section II, state the area (rural or urban) for which reclassification is requested and provide the respective identification code.
6. Complete the required selection for the reclassification criteria applicable to your group and fill out the related sections as indicated.
7. Address the general information section in Section III regarding the membership of hospitals in the group and whether they have pending reclassification requests.
8. For adjacency and metropolitan character in Sections IV and V, indicate yes or no based on the criteria provided and attach required maps or census data as supporting documents.
9. Complete the CSA/CBSA criteria in Section VI if applicable, and ensure to attach the necessary listings from the U.S. Census Bureau.
10. Attach supporting documentation as needed for wage criteria and any affidavits that confirm the authenticity of the application.
11. At the final stage, review your form for accuracy, save your changes, and choose to download, print, or share the completed application as required.

Start filling out your MGCRB Group Application for 2016 online today to ensure timely submission.